Bill 2 didn't just anger doctors. It left hundreds of millions in health-care funding in limbo

Hundreds of millions of dollars meant to be invested in Quebec’s beleaguered health-care network remains in limbo more than a month after the Legault government abolished the institute overseeing the funds without warning.

The Institut de pertinence des actes médicaux (IPAM), which began operations in March 2020, was mandated to identify appropriate medical practices and savings to reinvest in projects that would improve Quebecers’ access to specialized medical services. 

IPAM identified $1.9 billion in savings since its inception — $1.6 billion of which are from cuts to the remuneration of specialized physicians agreed upon in 2019, according to the institute’s latest financial report.

However, Bill 2, which ties a portion of physicians’ compensation to collective performance targets, marked the unceremonious end of the independent organization and now leaves these funds at the government’s discretion.  

The bill has been in place since Oct. 25, with the controversial changes it outlines set to go into effect on Jan. 1, 2026.

About $1.5 billion of the funds has already been committed to 57 projects, the report says. Of that sum, less than half — $645 million — was spent on the initiatives as of March 31, and it is unclear whether the remainder will still go to the original projects.   

There is also about $450 million that was not yet earmarked and could be used to invest in medical services.

Jean-François Foisy, director general of IPAM, said the institute was fulfilling its mandate, bearing in mind that the organization was expected to exist until Dec. 31, 2026.

He said that in the last year, IPAM, the Fédération des médecins spécialistes du Québec (FMSQ) and the government’s work had gained momentum, which made finding out that Bill 2 would put an end to the institute all the more shocking to him. 

“It's no longer our responsibility, but our hope is that there will be a way so that the network, in collaboration with Quebec’s Health Ministry and medical specialists, can continue to work and implement projects that, frankly, were quite promising,” Foisy said. 

Above all, Foisy said he hopes that considerations over the appropriateness of care will be at the heart of discussions about the health network going forward.  

Dr. Julie Jomphe —  a psychiatrist and associate professor at Université de Montréal —  said the abolishment of IPAM jeopardizes the availability of specialized medical care for people in need who are living in remote regions of Quebec, where services are scarce. 

“Fundamentally, there's inequity in Quebec. Some regions have specialized services, while others don't,” Jomphe said in an interview. 

On the eve of Bill’s 2 adoption, she had pitched an online group therapy project for people suffering from borderline personality disorder. It is estimated to cost at most $30,000 per year and is the kind of initiative that IPAM could have subsidized, she said.